Haldol (Haloperidol)
In an era where physicians and pharmacists are paying strict attention to FDA approval status, it’s interesting to note that IM haloperidol is solely approved for ‘treatment of schizophrenia - Scott Zeller MD
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Understanding Haloperidol
Belgian scientists first synthesized Haloperidol in 1958 as part of an effort to create new analgesics. They quickly learned that while haloperidol did not have analgesic properties, it was a powerful neuroleptic. Within a decade haloperidol was widely used in the United States as an anti-psychotic and anti-hallucinogenic drug. Today, haloperidol and other typical antipsychotics have largely been replaced for chronic treatment of psychiatric conditions by atypical antipsychotics such as risperidone, quetiapine, and olanzepine, which have lower rates of extrapyramidal symptoms and are often better tolerated.
Articles of Interest
Diabetic Gastroparesis Needs HUGS
Clinical Take Home Point: In this small, retrospective study, 5mg IM Haldol decreased rates of admission and amounts of opioids administered in patients with diabetic gastroparesis. Haldol could be a potential addition to the armamentarium of treatment in this difficult to treat disease process.
Haloperidol for Headaches. St Emlyn’s
It is reassuring that there were no cardiovascular complications with the administration of Haloperidol in this trial, though it still was not without side effects. This trial is unlikely to change our clinical practice in Virchester for the management of severe benign headache. It would be interesting to see a further RCT comparing Haloperidol to standard treatment.
Haloperidol for Treatment of Headache in the Emergency Department
With a low side-effect profile, emergency physicians should consider the use of 2.5 mg IV haloperidol as a rapid and effective treatment for acute benign headache in adult emergency department patients aged 18 to 55 years old.
Haloperidol in the Emergency Department Setting
Since the 1980’s, intramuscular (IM) haloperidol has been a mainstay of emergency rooms (ERs) and psychiatric facilities. Frequently given as part of a cocktail with lorazepam (often known as the “B-52” or “HAC”), it has been a default treatment, along with physical restraints, for patients with acute agitation in these settings.
Point-Counterpoint | IV Haloperidol Should be Avoided in the Emergency Department
These authors had the following key points to make for why IV haloperidol should NOT be used in the ED.
Should Diphenhydramine be included in an Acute Agitation Regimen?
Diphenhydramine may not be necessary when using haloperidol + lorazepam to treat agitation in the ED. ED length of stay is increased with the addition of diphenhydramine to haloperidol + lorazepam.
Time to retire haloperidol?
In this article, I discuss whether haloperidol, a first-generation antipsychotic (FGA) medication developed in 1958, still deserves to be the IM “gold standard” for managing emergency psychiatric agitation
To B or Not to B: B52 v 52 for Acute Agitation
Diphenhydramine (B) has historically been utilized in combination with haloperidol 5mg and lorazepam 2mg in the treatment of acute agitation. The most common rationale for adding diphenhydramine is prevention of EPS, however literature to support this is lacking.
Resources
StatPearls
Haloperidol is a first-generation typical antipsychotic drug that is commonly used worldwide. The medication is considered a typical antipsychotic as it manages the positive symptoms of schizophrenia, including hallucinations and delusions.
